Physicians' Academy for Cardiovascular Education

Physical activity is associated with reduced risk of mortality and CVD in all regions of the world

The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study

Literature - Lear SA, Hu W, Rangarajan S, et al. - Lancet 2017; published online ahead of print


70% of global CVD deaths come from low- and middle-income countries, where it is the commonest cause of death [1]. Many studies from high-income countries have reported significant inverse associations of physical activity with mortality and CVD morbidity, but there are not enough data on this topic from low- and middle-income countries [2,3].

In this analysis of 130 843 participants in the PURE study, the association between physical activity and the risk of mortality and CVD was evaluated, in countries at varying economic levels. It was also evaluated whether this association differs by type of physical activity.

The PURE study includes 168 916 participants from:

The 1-week total physical activity was assessed using the long-form International Physical Activity Questionnaire (IPAQ), and calculated as a total of occupation, transportation, housework, and recreational activity reported in metabolic equivalents (MET) × minutes per week [4].

The total physical activity was categorized as:

Physical activity meeting current guidelines is ≥600 MET × minutes per week [5].

Primary clinical outcomes during follow-up were mortality plus major CVD (CVD mortality plus incident MI, stroke, or HF), either as a composite or separately.

Main results


Physical activity is associated with a lower risk for mortality and major CVD events, independently of the type of physical activity and other risk factors, in all major regions of the world and various country economic levels. These results show that physical activity is a global low-cost approach to reducing deaths and CVD, which supports public health interventions to increase all forms of physical activity in countries of different socioeconomic circumstances.

Editorial comment

In their editorial article [6], Goenka and Lee note about the study published by Lear et al: ‘This is another confirmation that physical activity has definite and dose-dependent benefits for lowering risks of all-cause mortality and cardiovascular disease (heart attacks, stroke, and heart failure).’ They emphasize the need to take action to inform people about the benefits of physical activity, particularly in low-income countries, as well as the need to create and emphasize initiatives that will motivate people to undertake more physical activity.

The authors conclude: ‘Promotion of physical activity, active transport, and active living by means of interventions contextualized to culture and context will have powerful and long lasting effects on population health and developmental sustainability.’


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